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In the present work, the preparation and characterization of quasi-solid polymer electrolyte membranes based on methacrylic monomers and oligomers, with the addition of organic plasticizers and lithium salt, are described. Noticeable improvements in the mechanical properties by reinforcement with natural cellulose hand-sheets or nanoscale microfibrillated cellulose fibers are also demonstrated. The ionic conductivity of the various prepared membranes is very high, with average values approaching 10-3 S cm-1 at ambient temperature. The electrochemical stability window is wide (anodic breakdown voltages > 4.5 V vs. Li in all the cases) along with good cyclability in lithium cells at ambient temperature. The galvanostatic cycling tests are conducted by constructing laboratory-scale lithium cells using LiFePO4 as cathode and lithium metal as anode with the selected polymer electrolyte membrane as the electrolyte separator. The results obtained demonstrate that UV induced radical photo-polymerization is a well suited method for an easy and rapid preparation of easy tunable quasi-solid polymer electrolyte membranes for energy storage devices.

The parenteral administration of combinations of drugs is often necessary in palliative medicine, particularly in the terminal stage of life, when patients are no longer able to take medication orally. The use of infusers to administer continuous subcutaneous infusions is a well-established practice in the palliative care setting and enables several drugs to be given simultaneously, avoiding the need for repeated administrations and the effects of peaks and troughs in the doses of medication. The method is also appreciated by patients and caregivers in the home care setting because the devices and infusion sites are easy to manage. Despite their frequent use, however, the mixtures of drugs adopted in clinical practice are sometimes not supported by reliable data concerning their chemical and physical compatibility. The present study investigates the chemical compatibility of binary mixtures (morphine with ketorolac) and the physical compatibility of binary (morphine or methadone with ketorolac) or ternary mixtures (morphine with ketorolac and/or haloperidol, and/or dexamethasone, and/or metoclopramide, and/or hyoscine butylbromide) with a view to reducing the aleatory nature of the empirical use of such combinations, thereby increasing their safety and clinical appropriateness.

Background: The observation of action done by others determines a desynchronization of the rhythms recorded from cortical central regions. Here, we examined whether the observation of different types of hand movements (target directed, non-target directed, cyclic and non-cyclic) elicits different EEG cortical temporal patterns., Methodology: Video-clips of four types of hand movements were shown to right-handed healthy participants. Two were target directed (grasping and pointing) motor acts; two were non-target directed (supinating and clenching) movements. Grasping and supinating were performed once, while pointing and clenching twice (cyclic movements). High-density EEG was recorded and analyzed by means of wavelet transform, subdividing the time course in time bins of 200 ms. The observation of all presented movements produced a desynchronization of alpha and beta rhythms in central and parietal regions. The rhythms desynchronized as soon as the hand movement started, the nadir being reached around 700 ms after movement onset. At the end of the movement, a large power rebound occurred for all bands. Target and non-target directed movements produced an alpha band desynchronization in the central electrodes at the same time, but with a stronger desynchronization and a prolonged rebound for target directed motor acts. Most interestingly, there was a clear correlation between the velocity profile of the observed movements and beta band modulation., Significance: Our data show that the observation of motor acts determines a modulation of cortical rhythm analogous to that occurring during motor act execution. In particular, the cortical motor system closely follows the velocity of the observed movements. This finding provides strong evidence for the presence in humans of a mechanism (mirror mechanism) mapping action observation on action execution motor programs.

Introduction: The modulation of the renin angiotensin aldosterone system (RAAS) is an important pathway in managing high blood pressure, and its overexpression plays a key role in target end-organ damage. Telmisartan is an angiotensin II receptor blocker (ARB) with unique pharmacologic properties, including the longest half-life among all ARBs; this leads to a significant and 24-h sustained reduction of blood pressure. Telmisartan has well-known antihypertensive properties, but there is also strong clinical evidence that it reduces left ventricular hypertrophy, arterial stiffness and the recurrence of atrial fibrillation, and confers renoprotection., Areas Covered: This paper reviews telmisartan's pharmacological properties in terms of efficacy for hypertension control and, importantly, focuses on its new therapeutic indications and their clinical implications., Expert Opinion: ONTARGET (ongoing telmisartan alone and in combination with ramipril global endpoint trial) demonstrated, that telmisartan confers cardiovascular protective effects similar to those of ramipril, but with a better tolerability. Moreover, recent investigations focused on the capability of telmisartan to modulate the peroxisome proliferator-activated receptor-gamma (PPAR-γ), an established target in the treatment of insulin resistance, diabetes and metabolic syndrome, whose activation is also correlated to anti-inflammatory and, finally, anti-atherosclerotic properties. Telmisartan shows peculiar features that go beyond blood pressure control. It presents promising and unique protective properties against target end-organ damage, potentially able to open a scenario of new therapeutic approaches to cardiovascular disease.

Understanding actions of conspecifics is a fundamental social ability depending largely on the activation of a parieto-frontal network. Using functional MRI (fMRI), we studied how goal-directed movements (i.e., motor acts) performed by others are coded within this network. In the first experiment, we presented volunteers with video clips showing four different motor acts (dragging, dropping, grasping, and pushing) performed with different effectors (foot, hand, and mouth). We found that the coding of observed motor acts differed between premotor and parietal cortex. In the premotor cortex, they clustered according to the effector used, and in the inferior parietal lobule (IPL), they clustered according to the type of the observed motor act, regardless of the effector. Two subsequent experiments in which we directly contrasted these four motor acts indicated that, in IPL, the observed motor acts are coded according to the relationship between agent and object: Movements bringing the object toward the agent (grasping and dragging) activate a site corresponding approximately to the ventral part of the putative human AIP (phAIP), whereas movements moving the object away from the agent (pushing and dropping) are clustered dorsally within this area. These data provide indications that the phAIP region plays a role in categorizing motor acts according to their behavioral significance. In addition, our results suggest that in the case of motor acts typically done with the hand, the representations of such acts in phAIP are used as templates for coding motor acts executed with other effectors.

The treatment of moderate or severe hypertension in most cases requires the contemporaneous use of multiple antihypertensive agents. The most available two-drug combinations have an agent that addresses renin secretion and another one that is statistically more effective in renin-independent hypertension. The practice of combining agents that counteract different mechanisms is the most likely explanation for the fact that most available two-drug combinations have an agent that addresses renin secretion (beta-blocker, angiotensin converting enzyme inhibitor, angiotensin II receptor blocker or direct renin inhibitor) and another one that is more effective in renin-independent hypertension (diuretic, dihydropyridine or non-dihydropyridine calcium channel blocker). Based on these considerations, addition of hydrochlorothiazide to the combination of an antagonist of the renin-angiotensin system with a calcium channel blocker would constitute a logical approach. Inclusion of a diuretic in the triple combination is based on the evidence that these agents are effective and cheap, enhance the effect of other antihypertensive agents, and add a specific effect to individuals with salt-sensitivity of blood pressure. The benefit of triple combination therapy with amlodipine, valsartan and hydrochlorothiazide over its dual component therapies has been demonstrated, and the use of a single pill will simplify therapy resulting in better blood pressure control.

Hypertension is one of the major risk factors associated with cardiovascular diseases. A range of blood pressure-lowering agents is available including diuretics, alpha- and beta-blockers, aldosterone antagonists, calcium-channel blockers (CCB), angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB) and direct renin inhibitors (DRI). Most patients require two or more medications to control their blood pressures within normal ranges. When high blood pressure cannot be controlled by low-dose monotherapy, physicians employ either high-dose monotherapy or combination therapy. High-dose ARB monotherapy is more effective for reducing proteinuria against low-dose ARB monotherapy or CCBs. Combination therapy is recommended for hypertension patients to facilitate prompt maintenance of blood pressure. Single-pill combination therapy simplifies treatment and optimizes long-term compliance. Thiazide diuretics such as hydrochlorothiazide (HCTZ), alone or in combination are still widely used as first-line hypertension treatment. Recent studies have shown that double (CCB+ARBs) or triple (CCB+ARBs+HCTZ) combination therapies have a greater lowering efficacy and are better tolerated. Moreover, the use of DRIs has been patented and proven effective in selected categories of hypertensive patients with or without concomitant target organ damage (TOD).

Angiotensin II is a vasoactive hormone of the renin-angiotensin system and plays an important role in the pathophysiology of several organ damages. Angiotensin II receptor blockers have been shown to be effective in treating both hypertension and connected organ damages. It is well known that although the angiotensin II receptor blockers have structural and pharmacokinetic differences, few pharmacological differences separate them. One of these is the degree of binding to the angiotensin II receptor type 1 compared with the angiotensin II receptor type 2; olmesartan medoxomil exhibits more than a 12,500-fold greater affinity for the angiotensin II receptor type 1 receptor than for the angiotensin II receptor type 2, making it theoretically the second most potent agent. However, olmesartan's excellent receptor interaction is based on the combination of several specific pharmacokinetic factors. Potential advantages of this drug include once-daily dosing, a very low incidence of significant adverse reactions and/or events and a well-tolerated side effect profile. Nowadays, we have a lot of information about the pharmacology, antihypertensive efficacy and safety of olmesartan medoxomil, to further extend many clinical studies are still continuing to evaluate the potential benefits of high dosages and/or combination of this molecule.

One of the most exciting events in neurosciences over the past few years has been the discovery of a mechanism that unifies action perception and action execution. The essence of this 'mirror' mechanism is as follows: whenever individuals observe an action being done by someone else, a set of neurons that code for that action is activated in the observers' motor system. Since the observers are aware of the outcome of their motor acts, they also understand what the other individual is doing without the need for intermediate cognitive mediation. In this Review, after discussing the most pertinent data concerning the mirror mechanism, we examine the clinical relevance of this mechanism. We first discuss the relationship between mirror mechanism impairment and some core symptoms of autism. We then outline the theoretical principles of neurorehabilitation strategies based on the mirror mechanism. We conclude by examining the relationship between the mirror mechanism and some features of the environmental dependency syndromes.

It has been suggested that the deficit in understanding others' intention in autism depends on a malfunctioning of the mirror system. This malfunction could be due either to a deficit of the basic mirror mechanism or to a disorganization of chained action organization on which the mirror understanding of others' intention is based. Here we tested this last hypothesis investigating the kinematics of intentional actions. Children with autism and typically developing children (TD) were asked to execute two actions consisting each of three motor acts: the first was identical in both actions while the last varied for its difficulty. The result showed that, unlike in TD children, in children with autism the kinematics of the first motor act was not modulated by the task difficulty. This finding strongly supports the notion that children with autism have a deficit in chaining motor acts into a global action.

When we observe a motor act (e.g. grasping a cup) done by another individual, we extract, according to how the motor act is performed and its context, two types of information: the goal (grasping) and the intention underlying it (e.g. grasping for drinking). Here we examined whether children with autistic spectrum disorder (ASD) are able to understand these two aspects of motor acts. Two experiments were carried out. In the first, one group of high-functioning children with ASD and one of typically developing (TD) children were presented with pictures showing hand-object interactions and asked what the individual was doing and why. In half of the "why" trials the observed grip was congruent with the function of the object ("why-use" trials), in the other half it corresponded to the grip typically used to move that object ("why-place" trials). The results showed that children with ASD have no difficulties in reporting the goals of individual motor acts. In contrast they made several errors in the why task with all errors occurring in the "why-place" trials. In the second experiment the same two groups of children saw pictures showing a hand-grip congruent with the object use, but within a context suggesting either the use of the object or its placement into a container. Here children with ASD performed as TD children, correctly indicating the agent's intention. In conclusion, our data show that understanding others' intentions can occur in two ways: by relying on motor information derived from the hand-object interaction, and by using functional information derived from the object's standard use. Children with ASD have no deficit in the second type of understanding, while they have difficulties in understanding others' intentions when they have to rely exclusively on motor cues.

Achieving blood pressure (BP) targets in stage 2 hypertension usually requires two or more drugs, which should be selected from different classes. This study compared the efficacy and tolerability of amlodipine/valsartan with amlodipine in patients with stage 2 hypertension. In this multicenter, randomized, double-blind, 8-week study, 646 patients with stage 2 hypertension (mean sitting systolic blood pressure [MSSBP] >/=160 mm Hg) received amlodipine/valsartan 5/160 mg or amlodipine 5 mg for 2 weeks, prior to being force-titrated to amlodipine/valsartan 10/160 mg or amlodipine 10 mg, respectively, for a further 6 weeks. Hydrochlorothiazide could be added at Week 4 if MSSBP was >/=130 mm Hg. At endpoint Week 4, reductions in MSSBP were significantly greater in patients receiving amlodipine/valsartan than in those receiving amlodipine (30.1 mm Hg vs. 23.5 mm Hg; P < .0001). Likewise, MSSBP reductions in patients with baseline MSSBP >/=180 mm Hg were also greater for amlodipine/valsartan at Week 4 (40.1 mm Hg vs. 31.7 mm Hg for amlodipine; P = .0018). Differences favoring amlodipine/valsartan were also seen for BP control. Amlodipine/valsartan was generally well tolerated. These findings support the rationale for combining agents with complementary mechanisms of action, such as amlodipine and valsartan, in the management of stage 2 hypertension.

L. monocytogenes is a foodborne psychrotrophic bacterial pathogen of special importance for minimally processed foods. In this work, it was enumerated in samples of surubim fish by MPN technique. The population of L. monocytogenes was estimated as < 0.012 MPN/cm(2) in fresh and < 0.03 MPN/g in minimally processed fish.

Mirror neurons are a distinct class of neurons that transform specific sensory information into a motor format. Mirror neurons have been originally discovered in the premotor and parietal cortex of the monkey. Subsequent neurophysiological (TMS, EEG, MEG) and brain imaging studies have shown that a mirror mechanism is also present in humans. According to its anatomical locations, mirror mechanism plays a role in action and intention understanding, imitation, speech, and emotion feeling.

The aim of the present work was to test the ability to predict the instant at which a grasping hand touches an object. Our hypothesis was that, because of the activation of the mirror-neuron system, the same predictive process necessary for action execution should be active during observation. Experimental evidence indicates, however, that not only observed actions but also observed objects automatically activate observer's motor repertoire. What happens, therefore, if the observed action is different from the one automatically evoked by the vision of the object? To answer this question we presented subjects with two different grasping actions: the one most suitable for the presented object and a less appropriate one. Subjects were required to detect the instant at which the demonstrator's hand touched the object. In a further condition, subjects were required to detect the outcome of an action performed by a robotic arm moving with constant kinematics. Results showed that while in the case of robot grasping subjects responded before the touch instant, in the case of human grasping the response followed the touch instant, but occurred much earlier than simple reaction times. This demonstrates that subjects were able to predict the outcome of the seen action. The predictive capability was specifically enhanced during observation of the "suitable" grasping. We interpret these results as an indication of the synergic contribution of both object-related (canonical) and action-related (mirror) neurons during observation of actions directed towards graspable objects.

Experiments in monkeys have shown that coding the goal of the motor acts is a fundamental property of the cortical motor system. In area F5, goal-coding motor neurons are also activated by observing motor acts done by others (the 'classical' mirror mechanism); in area F2 and area F1, some motor neurons are activated by the mere observation of goal-directed movements of a cursor displayed on a computer screen (a 'mirror-like' mechanism). Experiments in humans and monkeys have shown that the mirror mechanism enables the observer to understand the intention behind an observed motor act, in addition to the goal of it. Growing evidence shows that a deficit in the mirror mechanism underlies some aspects of autism.

Listeria monocytogenes is a cause of concern to food industries, mainly for those producing ready-to-eat (RTE) products. This microorganism can survive processing steps such as curing and cold smoking and is capable of growing under refrigeration temperatures. Its presence in RTE fish products with extended shelf life may be a risk to the susceptible population. One example of such a product is gravlax salmon; a refrigerated fish product not exposed to listericidal processes and was the subject of this study. In order to evaluate the incidence and dissemination of L. monocytogenes 415 samples were collected at different steps of a gravlax salmon processing line in São Paulo state, Brazil. L. monocytogenes was confirmed in salmon samples (41%), food contact surfaces (32%), non-food contact surfaces (43%) and of food handlers' samples (34%), but could not be detected in any ingredient. 179 L. monocytogenes isolates randomly selected were serogrouped and typed by PFGE. Most of L. monocytogenes strains belonged to serogroup 1 (73%). 61 combined pulsotypes were found and a dendrogram identified six clusters: most of the strains (120) belonged to cluster A. It was suggested that strains arriving into the plant via raw material could establish themselves in the processing environment contaminating the final product. The wide dissemination of L. monocytogenes in this plant indicates that a great effort has to be taken to eliminate the microorganism from these premises, even though it was not observed multiplication of the microorganism in the final product stored at 4°C up to 90 days.

Background: The potential combinations of antihypertensive agents are many, and making rational choices depends on the characteristics of each drug and on their complementary mechanisms of action., Objective: The aim of this study was to evaluate the effectiveness of adding hydrochlorothiazide (HCTZ) 12.5 mg to olmesartan 20 mg or telmisartan 80 mg on blood pressure (BP) in patients with moderate hypertension., Methods: Consecutive outpatients at the Centro per l'Ipertensione e la Fisiopatologia Cardiovascolare, University of Pavia, Pavia, Italy, of both sexes aged 39 to 75 years were considered eligible for enrollment if they had a sitting diastolic BP (DBP) ->99 mm Hg and <110 mm Hg at the end of an initial 2-week washout period. Patients were random- ized to olmesartan 20 mg QD or telmisartan 80 mg QD according to a prospective, open-label, blinded end point, parallel-arm design. After 8 weeks of monotherapy, patients whose BP was not controlled (DBP ->90 mm Hg) received HCTZ 12.5 mg QD for 8 additional weeks. Clinical and ambulatory BPs were measured at the end of the washout period and at the end of both treatment periods. Adverse events (AEs) were recorded from spontaneous reports and direct inquiry from investigators., Results: One hundred forty-five patients, all of whom were white, were recruited for the study. After the initial washout period, 13 patients did not meet the inclusion criteria and 6 refused to continue. A total of 126 white patients (69 men, 57 women; mean [SD] age, 60.2 [11.6] years) were randomized to receive monotherapy. Of these, 35 patients (56%) in the olmesartan group and 33 (52%) in the telmisartan group had previously received antihypertensive therapy. At the end of monotherapy, the 52 patients in the olmesartan group and the 49 patients in the telmisartan treatment group who were still in the study and had their BP inadequately controlled by treatment had HCTZ 12.5 mg QD added to their treatment regimen. Both combinations induced a greater ambulatory mean (SD) systolic BP (SBP) and DBP reduction than monothera- py (SBP: 145.3 [6.1] in the olmesartan group and 140.1 [6.4] in the telmisartan group, P < 0.05; DBP: 88.1 [5.1] in the olmesartan group and 84.9 [4.9] in the telmisartan group, P < 0.05). The mean (SD) reduction from baseline in the telmisartan/HCTZ-treated patients (21.5 [10.1]/14.6 [5.2] mm Hg for 24 hours, 21.8 [10.2]/14.9 [5.2] mm Hg for daytime, and 20.4 [10.3]/13.7 [5.9] mm Hg for nighttime; all, P < 0.001 vs baseline) was significantly greater than that observed in the olmesartan/HCTZ-treated patients (18.8 [9.8]/12.3 [4.9] mm Hg for 24 hours, 19.3 [9.8]/12.8 [4.9] mm Hg for daytime, and 17.4 [10.2]/10.6 [5.5] mm Hg for nighttime; all, P < 0.001 vs baseline), with a significant difference between the 2 treatment groups (P < 0.01). Compared with mono- therapy, the add-on effect of HCTZ 12.5 mg QD administration was significantly greater in the telmisartan group than in the olmesartan group (P < 0.05); the differ- ence being more evident for nighttime BP values (SBP, P 0.031; DBP, P 0.025). Reported AEs were similar in the olmesartan/HCTZ and the telmisartan/HCTZ groups (4 patients [7%] vs 3 patients [6%])., Conclusion: The addition of HCTZ 12.5 mg to telmisartan 80 mg monothera- py was associated with greater BP reduction than the addition of the same dose of HCTZ to olmesartan 20 nag monotherapy in these patients previously uncontrolled on monotherapy.

In the present study, we used transcranial magnetic stimulation (TMS) to investigate the influence of phonological and lexical properties of verbal items on the excitability of the tongue's cortical motor representation during passive listening. In particular, we aimed to clarify if the difference in tongue motor excitability found during listening to words and pseudo-words [Fadiga, L., Craighero, L., Buccino, G., Rizzolatti, G., 2002. Speech listening specifically modulates the excitability of tongue muscles: a TMS study. European Journal of Neuroscience 15, 399-402] is due to lexical frequency or to the presence of a meaning per se. In order to do this, we investigated the time-course of tongue motor-evoked potentials (MEPs) during listening to frequent words, rare words, and pseudo-words embedded with a double consonant requiring relevant tongue movements for its pronunciation. Results showed that at the later stimulation intervals (200 and 300 ms from the double consonant) listening to rare words evoked much larger MEPs than listening to frequent words. Moreover, by comparing pseudo-words embedded with a double consonant requiring or not tongue movements, we found that a pure phonological motor resonance was present only 100 ms after the double consonant. Thus, while the phonological motor resonance appears very early, the lexical-dependent motor facilitation takes more time to appear and depends on the frequency of the stimuli. The present results indicate that the motor system responsible for phonoarticulatory movements during speech production is also involved during speech listening in a strictly specific way. This motor facilitation reflects both the difference in the phonoarticulatory characteristics and the difference in the frequency of occurrence of the verbal material.

Experiments in monkeys demonstrated that many parietal and premotor neurons coding a specific motor act (e.g., grasping) show a markedly different activation when this act is part of actions that have different goals (e.g., grasping for eating vs. grasping for placing). Many of these "action-constrained" neurons have mirror properties firing selectively to the observation of the initial motor act of the actions to which they belong motorically. By activating a specific action chain from its very outset, this mechanism allows the observers to have an internal copy of the whole action before its execution, thus enabling them to understand directly the agent's intention. Using electromyographic recordings, we show that a similar chained organization exists in typically developing children, whereas it is impaired in children with autism. We propose that, as a consequence of this functional impairment, high-functioning autistic children may understand the intentions of others cognitively but lack the mechanism for understanding them experientially.

The aim of the study was to evaluate the effect of losartan as compared with amlodipine, both associated with amiodarone, in preventing the recurrence of atrial fibrillation (AF) in hypertensive patients with a history of recent paroxysmal atrial fibrillation. Two hundred and fifty mild hypertensive (SBP > 140 mm Hg and/or DBP > 90 < 100 mm Hg) outpatients in sinus rhythm but with at least two ECG-documented episodes of symptomatic atrial fibrillation in the previous 6 months and in treatment with amiodarone were randomized to losartan or amlodipine and were followed up for 1 year. Clinic blood pressure (BP) and a 24-hour ECG was evaluated every month; the patients were asked to report any episode of symptomatic atrial fibrillation and to perform an ECG as early as possible. Two hundred and thirteen patients completed the study, 107 in the losartan group and 106 in the amlodipine group. After 12 months the SBP/DBP mean values were significantly reduced by both losartan (from 151.4/95.6 to 135.5/83.7 mm Hg, P < 0.001 versus baseline) and amlodipine (from 152.3/96.5 to 135.2/83.4 mm Hg, P < 0.001 versus baseline), with no difference between the two treatments. At least one ECG-documented episode of atrial fibrillation was reported in 13% of the patients treated with losartan and in 39% of the patients treated with amlodipine. The use of losartan in combination with amiodarone seems more effective than amlodipine/amiodarone combination in preventing new episodes of atrial fibrillation in hypertensive patients with recurrent atrial fibrillation. This might be related to possible favorable impact of angiotensin II receptor blockers (ARB) on the atrial electrical and structural remodeling in this type of patients.

Cherubism is a rare hereditary fibro-osseous childhood disease characterized by bone degradation and fibrous tissue replacement at the angles of the mandible and at the tuberosity areas of the maxilla that leads to prominence of the lower face and an appearance reminiscent of the cherub's portrayal in Renaissance art. This disease has an autosomal dominant hereditary characteristic. The purpose of this report is to analyse laboratory tests, clinicopathological and radiographic features of cherubism and its intraoral manifestations in a patient during 4-years of follow-up, correlating the features observed in this case with those of the literature. Also discussed is the atypical and aggressive behaviour of this case during puberty.

Objective: The aim of this open-labelled, randomised, parallel-group study was to evaluate the effect of long-term monotherapy with manidipine or lisinopril on albumin excretion rate (AER) and left ventricular mass index (LVMI) in hypertensive patients with type-2 diabetes and microalbuminuria., Methods: After a 4-week wash-out period, 174 patients with essential hypertension [diastolic blood pressure (DBP) >80 mmHg and <100 mmHg], type-2 diabetes and microalbuminuria were randomised to manidipine 10 mg o.d. or lisinopril 10 mg o.d.; after 8 weeks, the dose was doubled in non-responders (DBP >80 mmHg); after 3 months, treatment was discontinued in the non-responder patients and in those complaining of side effects; the remaining 121 patients continued their therapy with manidipine or lisinopril, and 99 completed the 2-year study. At the end of the wash-out period, of the titration period and after 6, 12, 18 and 24 months of treatment, BP was measured, AER, creatinine clearance, glycosylated haemoglobin (HbA1c) and body mass index (BMI) were evaluated and an echocardiographic evaluation was performed., Results: The 99 patients who completed the study were statistically analysed according to a per-protocol evaluation. Manidipine and lisinopril significantly reduced systolic blood pressure (SBP) and DBP levels (at 24 months, --22.3/15.5 mmHg, P<0.001 versus baseline and --21.4/15.7 mmHg, P<0.01 versus baseline, respectively). Both drugs provided a significant decrease in AER, but it was significantly more pronounced with lisinopril (at 24 weeks, --37.2 mg/24 h, P<0.001 versus baseline) than with manidipine (--29.9 mg/24 h, P<0.05 versus baseline) and became evident earlier in the lisinopril group (after 3 months versus 6 months of treatment). Manidipine produced a greater reduction of LVMI than lisinopril (--14.9 g/m(2) versus --10.8 g/m(2) at 24 months). The effect was more pronounced in patients with left ventricular hypertrophy at baseline (--19.8 g/m(2) versus --12.8 g/m(2), P<0.05)., Conclusion: These data suggest that, despite similar BP lowering, non-haemodynamic factors play an important role in the pharmacological reduction of AER and LVMI in diabetic hypertensive patients.

A total of 207 L. monocytogenes strains isolated from different types of cheeses commercialized in the city of Rio de Janeiro, Brazil, were serotyped and evaluated for their ability to produce beta-haemolysin and lecithinase and to adsorb Congo red dye. Of the 207 strains, 59.9, 27.5 and 12.6% belonged to serotypes 1/2a, 1/2b and 4b, respectively. In addition, 175 strains of L. monocytogenes produced lecithinase while strains of the other species did not. Some of the non-L. monocytogenes strains adsorbed the dye Congo red, while some L. monocytogenes did not. Statistical analysis of the results showed significant differences (P < 0.05) amongst the virulence tests and the three serotypes found. In the present study, 32 L. monocytogenes strains were also analyzed by RAPD (randomly amplified polymorphic DNA). RAPD analysis allowed the discrimination among strains of different serotypes, as well as among strains of the same serotype. It is important to emphasize that the use of more than one primer is needed for characterization of L. monocytogenes strains. With RAPD the strains were grouped into six different profiles, some of them common for strains belonging to different serotypes. The results also indicated a close genetic relationship among strains of different serotypes.

The incidence of Salmonella spp., Listeria spp. and Listeria monocytogenes in horsemeat for human consumption was investigated. One-hundred and twenty-one samples of frozen horsemeat collected from two Brazilian abattoirs were analysed over a period of 1 year. Twenty-two samples (18.2%) were positive for Listeria spp. with nine (7.4%) containing L. monocytogenes. None of the samples harbored Salmonella spp.

We report a technique of auricular replantation used in a case of traumatic amputation. The principal difficulties encountered in this type of replantation are mentioned, and ways of avoiding them are suggested. All the skin of the ear was removed except for that of the anterior surface of the conch. At this site, the cartilage received small, multiple perforations to allow for nutrition of the corresponding skin. The remainder of the auricular cartilage was covered by a skin flap undermined from the mastoid region. Three months later, the retro-auricular region was freed and covered with a total skin graft taken from the right supraclavicular region. On the basis of the satisfactory results obtained, we discuss the intention and the technical details of the method and possible contraindications.

The optical and crystalline properties of PbF(2) thin films as a function of the substrate temperature during deposition have been studied; the other evaporation conditions were kept as constant as possible. Channel spectra, guided modes, and ellipsometry techniques were used for the analysis of the optical properties of the films. X-ray diffraction was used for the analysis of the crystalline structure.

To assess the prevalence of an impaired diurnal blood pressure (BP) pattern in a population of both normotensive and hypertensive diabetics, noninvasive ambulatory BP monitoring (SpaceLabs 5200, Redmond, WA) was performed in 96 outpatients with type 2 diabetes (47 normotensives and 48 hypertensives) and in 103 control subjects without diabetes (50 normotensives and 53 hypertensives). Mean 24 h and daytime (06:00 to 22:00) BP and heart rate (HR) were not statistically different in diabetic patients compared to nondiabetic ones. Nighttime (22:00 to 06:00) BP and HR tended to be higher in both normotensive and hypertensive diabetics, although not significantly. Heart rate, diastolic BP (DBP), and especially the nocturnal systolic BP (SBP) decrease, were less marked in both normotensive and hypertensive diabetics, with a consequent increase in rate-pressure. A significant correlation was found between the percent decrease in nighttime SBP and the decrease in orthostatic SBP in casual BP measurements. The analysis of individual recordings allowed us to detect an impaired circadian pattern (the disappearance of the nocturnal BP decrease or a paradoxical BP increase) in 30% of the normotensive and 31% of the hypertensive diabetics (v 6% of the normotensive and 6.4% of the hypertensive nondiabetic subjects). As the absence of a nocturnal BP fall has been associated with the increased prevalence of left ventricular hypertrophy and atherosclerotic cardiovascular disease, its detection by ambulatory monitoring might be of prognostic and therapeutic importance.

Small-signal gain and saturation intensity are obtained from input and output intensity measurements in a dye amplifier stage in which amplified spontaneous emission changes the amplifier performance. We demonstrate that these measurements lead to more accurate values for the effective gain of the amplifier than what can be obtained from theoretical calculations by using physical parameters of the dye. Furthermore, this method can be used to optimize the power extraction efficiency for a dye amplifier stage transversely pumped by a copper vapor laser.

The Authors report chromocolposcopic pictures with AZEA (Azure 2 + alcohol-soluble eosine + ethanol) and related histologic pictures in six women under oral contraception. Columnar epithelium develops violet or blue-violet areas histologically corresponding to endocervicitis. Aceto-white epithelium develops reddish color in case of medium-mature metaplasia, brown-violet in case of mature metaplasia, lilac in case of superficial koilocytosis on metaplasia. Native epithelium appears dark brown, or yellow-brown in case of koilocytosis.

Fifty-four patients were studied during the period from 1984 to 1989. The lower eyelid was repaired in 55 cases utilising a triangular flap with a subcutaneous pedicle. Repair was achieved in 39 cases with a triangular flap only and in 16 it was necessary to use a chondromucosal graft of nasal septum as well. The method is described and is feasible for repairs ranging from the simplest to the most complex in different locations of the lid.

Five patients presented with vision-threatening retinal tumors and systemic signs of neurofibromatosis, including neurofibromatosis type 1 (four patients) and familial cafe-au-lait spots (one patient). These tumors included large retinal astrocytic hamartomas, multiple retinal capillary hemangiomas, and combined hamartomas of the retina and retinal pigment epithelium, which resulted in rubeotic glaucoma, vitreous hemorrhage, and retinal detachment. Surgical therapy included retinal cryopexy, xenon and argon photocoagulation, scleral buckling, and pars plana vitrectomy with excisional retinal biopsy. Retinal tumors may result in marked visual loss in patients with neurofibromatosis, and vitreoretinal surgery may restore useful vision in some of these patients.

Previous studies indicate that the hamster fasted for 16 h fails to demonstrate a significant phosphaturic response to parathyroid hormone (PTH). However, when hamsters were infused with ammonium chloride, a phosphaturic response to PTH was observed. The present studies evaluate the respective roles of acidemia and the ammonium ion in this response. As in previous studies, fasted thyroparathyroidectomized (TPTX) hamsters infused with PTH showed no significant increase in the fractional excretion of phosphate (FE rho), from 19 +/- 2 to 22 +/- 1%. Neither respiratory acidosis (hypercapnia) nor metabolic acidosis (HCl infusion) enhanced the phosphaturic effect of PTH, FE rho 21 +/- 4 to 20 +/- 6 and 15 +/- 2 to 16 +/- 3%, respectively. Both ammonium chloride and ammonium bicarbonate infusions enhanced the phosphaturic response; FE rho increased from 15 +/- 5 to 27 +/- 5% (P < 0.02) and 17 +/- 3 to 25 +/- 3% (P < 0.05), respectively. We conclude that the enhancement of the phosphaturic effect of PTH in the fasted hamster by ammonium chloride infusions can be dissociated from acidemia.

The efficacy of the Terry quantitative surgical keratometer in minimizing early postoperative astigmatism was evaluated in a retrospective study. Intraoperative use of the Terry keratometer reduced the keratometric corneal astigmatism in the early postoperative period for the 6.5-mm chord length phacoemulsification-lens implant incision as well as for the 10.0-mm to 11.0-mm chord length planned extracapsular cataract extraction-lens implant incision. In addition, the 6.5-mm chord length incision yielded a significant reduction in early postoperative astigmatism when compared to the 10.0-mm to 11.0-mm chord length incision. Furthermore, there was a reduction in the number of patients who required suture cutting in the keratometer group. The Terry quantitative surgical keratometer is a useful tool for reducing early postoperative surgical astigmatism and decreases the number of patients who require suture cutting.

Choroidal neovascularization in rat eyes was induced by krypton laser photocoagulation. Lesions were studied weekly by ophthalmoscopy, fundus photography, and fluorescein angiography. Morphologic correlation was provided by serial sectioning of lesions for light and transmission electron microscopy. In addition, vascular casts were prepared for scanning electron microscopy. Choroidal neovascularization occurred in 25 (60%) of 42 lesions, as evidenced by growth of capillaries through breaks in Bruch's membrane. In addition, 24 (28%) of 86 lesions studied by fluorescein angiography demonstrated leakage. This study provides the most complete angiographic, histologic, and ultrastructural documentation of experimental choroidal neovascularization in the rat. This model may be useful for in vivo studies of choroidal angiogenesis and its modulation via drug therapy.

We used a pulsed erbium-YAG laser emitting in the midinfrared region (2.94 microns) to cut experimental vitreous membranes in rabbits via an intraocular fiberoptic delivery system. Thirty-four membranes were cut at distances of 500 to 3600 microns from the retina. All 34 of the membranes treated were effectively cut. Sixteen cases had no evidence of retinal injury, including one in which the membrane was only 800 microns from the retina. Retinal injuries in the remaining cases consisted of small (less than 300 microns) retinal burns and hemorrhages. In 94% of the cases with retinal injury, the fiberoptic was within 2000 microns of the retina. We conclude that a pulsed erbium-YAG laser allows near tractionless cutting of vitreous membranes and may have potential for clinical use if further studies show it to be efficacious and safe near the retina.

Leiomyosarcoma has been rarely encountered in the orbit. Leiomyosarcoma may arise as a primary tumor in the orbit, metastasize from distant sites to the orbit, extend into the orbit from the paranasal sinuses, or appear after radiation therapy to the orbit. The 43-year-old female patient described in this paper underwent excision of a leiomyosarcoma in the subcutaneous tissue of the buttock. Seven years later, a leiomyosarcoma in the medial orbit was removed. The clinical course of this patient's disease was similar to that of other subcutaneous leiomyosarcomas documented in the literature. Gynecological history was remarkable for a leiomyoma of the uterus, an interesting association found in at least one other case in the literature. This was the third documented case of metastatic leiomyosarcoma in the orbit.

The correlation between the placental echographic appearances and pulmonary maturity was studied in 32 cases of normal pregnancy between the 29th and 33d weeks. The placental appearance was classified according to Grannum's criteria, and an amniocentesis was performed in each case. Both an L/S ratio and a foam stability (Clements') test were performed on the amniotic fluid. There were 10 cases of grade I and 22 cases of grade II placenta in the series. There was one mature L/S ratio in each placental grade; both had intermediate results with Clements' test. These findings differ significantly from those published in the literature on the subject, which are based on investigations in more mature fetal populations.

Recessive epidermolysis bullosa dystrophica (REBD), a bullous disorder of the skin and mucous membranes, is frequently associated with ocular complications. A 40-year-old woman presented with lid ulcerations, chronic conjunctivitis, diffuse subepithelial corneal scarring, corneal ulceration, and cataracts. Management with intensive lubricant therapy, soft-bandage contact lenses, and cataract extraction successfully restored her sight. Histologic examination via light and electron microscopy revealed blister formation and scarring beneath the epithelial basement membrane of both the skin and cornea, confirming the diagnosis of REBD. The ultrastructure of the skin and cornea and the ocular complications of the major forms of epidermolysis are described herein. To our knowledge, successful ocular management of a confirmed case of REBD with complete ocular histopathologic features has not been documented.

Choroidal neovascular membranes often are poorly defined on fluorescein angiography because of rapid or indistinct fluorescein leakage or because of blockage of hyperfluorescence by overlying hemorrhage, lipid, turbid fluid, or pigment. Indocyanine green (ICG) is a high protein-bound dye with peak absorption (805 nm) and peak fluorescence (835 nm) in the near infrared portion of the spectrum. At these wavelengths, penetration through overlying pigments is increased. Using an infrared videoangiography system, the authors obtained ICG angiograms of 32 eyes with suspected choroidal neovascularization. Compared with fluorescein angiography, ICG improved visualization of the choroidal circulation and enhanced visualization of some membranes that were poorly defined with fluorescein. In addition, after clearance of the dye from the retinal and choroidal circulations, ICG remained in and around the neovascular tissue. The authors conclude that ICG videoangiography may aid in the evaluation of selected patients with poorly defined membranes on fluorescein angiography.